Thursday, December 20, 2007

Wow. Yet another celebrity is signing up for the O.R. (Christina Aguilera)? Say it ain't so. Surgery over a few hours of work to benefit both mom and her baby?! Vaginal birth IS the norm. Surgery is well SURGERY which can lead to incredible risks and consequences immediately and very long term. Yes there is frustration in my voice.

COME on already, MAJOR surgery is so much riskier than normal, routine, AWESOME childbirth. AAHH but perhaps therein lies the problem, normal, routine childbirth is very tough to attain these days with all the inductions with an against label use drug (cytotec), most labors being augmented with pitocin because a woman isn't fitting a time clock of daylight or one shift obstetrics, the planned paralysis of rampant epidural use, continuous fetal monitoring since the inductions, augmentation and epidurals makes women and babies high risk(and in essence straps said women to the bed), and then pushing a baby out while others yell at her and the woman is told to hold her breath while in a tremendously poor position choice (except the care provider can SEE), this leads to episiotomies or much more severe tearing than side-lying, squatting or hands and knees would provide or worse instrumental delivery - then to add insult to literal injury baby isn't allowed to be on mom for some beautiful bonding moments before being weighed and more.

OK perhaps that is one reason for all the refusal to use one's vagina for an intended purpose. The list could go on as for why maternity care and childbirth is so completely backwards in this country.

We are missing out dear women, sisters and friends. We need to reclaim what is our design, our privilege, our heritage, our right and our purpose.

I far too often hear women saying "My insurance doesn't cover the location, provider, type of birth I REALLY want. Well it will be okay anyway, won't it?." Or "We just bought XXXXX and cannot afford to pay for care out of pocket."

I wonder what are you willing to do to have the childbirth you deeply desire? It seems in other aspects of life when there is something we really want, somehow we find the time, money, etc. to attain it. Childbirth IS that important. Investing in what will help you achieve a normal birth can be preventative of unwanted interventions and cesarean.

Below is a list of ways to find the money for the birth center, family practitioner, home birth midwife, out of network provider, doula, independent childbirth class, waterbirth or whatever your heart is set upon to help in preparation and delivery of your baby.

A list of practical ways to find the money you need:

1) In lieu of traditional baby shower gifts (honestly much of the stuff is unnecessary to having a baby except for a good baby wearing item) - ask for a group gift of the provider or location payment (or at least monies to get you well on your way).

2) Trim down your budget - do you need the highest satellite or cable package, forgo eating out or picking up expensive drinks, forgo weekly entertainment expenses, have a yard sale or post on community boards all the items you do not use (your home will be much less cluttered for it), what about your cellular service - trim back if possible, sell your car and buy something less expensive, forgo expensive hair cuts or other beauty maintenance

3) Ask for family and friends to donate to your XXXXX fund.

4) Petition your insurance company to add XXXX provider or location to their provider list.

5) Figure out all your co-pays and see if you are really spending more or close to the same anyway for what you don't really want and can actually afford the care you really desire.

6) Set-up payment schedules with provider or location - often care can be paid for over the time of your pregnancy in increments.

7) Do you have a barter to offer? Try it!

8) Move to a lower cost home to save in rent or mortgage. Hey even moving in with family temporarily can work. Extended support is often a blessing.

9) Open a 125k flexible medical spending account (thanks to my DH for reminding me about this). This money comes out of your paycheck pre-tax and you can get reimbursed for out-of-pocket medical expenses in one calendar year, it lowers your taxable income and helps you attain what you want.

Sometimes sacrifice is needed. Sometimes just a bit of trimming. Being under the thumb of insurance or lack thereof doesn't have to define your options. Get creative. There is almost ALWAYS a way. It is worth it to you and your baby.

Thursday, December 6, 2007

These are quotes made up by a friend and I to cause a pause and thinking to occur. Sadly, they may sound very familiar to public opinion these days. This is meant to be a spoof, but also is a social commentary on how we as a society are giving up on the precious and magnificent work of normal labor and birth. As women, we are incredibly blessed to be the life growers and to bring life forth from our own bodies under our own power. The work of pregnancy, labor and delivery is just a glimpse into the daily work of being a mother. Motherhood like pregnancy through delivery is not always easy but at the end of the day worth it. I fear we are losing something of vast importance in our society.

This entry is biting and almost roast-like. Read with caution!

"Not my mama's vagina! Mine is only for sex."

"MY MRSA Antibiotics are so slimming..it was worth the infection I got during my cesarean!"

"Ob's say Vaginas are no longer for non-sexual use due to stressors destroying the capability for penis use"

"Men everywhere question the duality of vaginal use. Should they allow women to use their vaginas for birth?"

"Women are just saying NO to multi-purpose vaginal use"

"My vagina is progressive and evolved - no childbirth for me!"

"Kegels, schmegels - just get the cesarean."

"I thought to myself..they can't really do vaginal tightening..but I can always have another tummy tuck!"

"It was GREAT being able to schedule my induction...and the baby being in the NICU for a week meant that I got plenty of rest and was able to shop without interruption!"

"I was so ready for motherhood! I had a postpartum doula, a nanny and lots of dr. bronner's bottles! Oh, and once the baby came, the sleeper, the vibrating chair, the swing...they saved me! I never had to pick the baby up once! Just pacifier and away!"

"No vaginal birth for me! I am a modern woman."

"But none of my friends are using their vaginas for birth!"

Are you thinking yet? Screaming? Yelling at me? And by the way, it is okay to laugh.

Wednesday, December 5, 2007

Below is the current ICAN press release (http://www.ican-online.org/) in response to the CDC report released today regarding 2006 childbirth data (http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf ).The latest Colorado numbers (2006) are showing a 25.3% cesarean rate an increase of 2.8% since 2005. Though this is clearly lower than the national average, Colorado is still nearly double the reasonable cesarean rate of 10-15%. By no means should we feel comforted by this, falsely secure or safe knowing that other states have more extreme numbers.

I hope we are outraged that the current standard and attitude in maternity care is causing needless major surgery, allowing women to be lied to about true risk and benefit, injury to women and babies (even death), future fertility/pregnancy issues, emotional trauma, and financial strain personally and governmentally (I could go on and on).

It is time for women to take charge of their own care by insisting their provider use protocols and practices that are proven safe (almost always that would be normal unfettered vaginal birth) or vote with their wallets, insurance cards, and feet!

No peace today. Desirre

Cesarean Rate Hits a New High

Recent Studies Show Cesareans Can Pose Dangers to Mothers and Babies

Release Highlights:

Cesarean rate at record high in the U.S.

Cesarean rise coincides with CDC report that maternal death rate rising for the first time in decades.

World Health Organization data shows that mothers die at a higher rate in the U.S. than 40 other countries.

Consumer Reports includes cesarean on “10 overused tests and treatments”

Colorado Springs, CO, December 5, 2007 – The National Center for Health Statistics has reported that the cesarean rate has hit an all-time high of 31.1 percent.

“Cesarean section is major surgery and doctors are overusing it on women and their babies,” said Desirre Andrews. “People tend to think because cesareans are common that they are risk-free, but unfortunately, many women and babies are paying the high price of complications from this surgery.”

For the second year in a row, ICAN has compiled a list of research from the past year that shows cesarean surgery should be used more judiciously and that VBAC should be used more routinely. (See attached) Currently, more than 300 hospitals across the U.S. ban women from having a VBAC, essentially coercing them into unnecessary surgery and feeding the growing rate of cesarean. In Colorado, all of the western slope hospitals have joined this trend.

The risks of cesarean were tragically highlighted this year by a rash of deaths related to the surgery, including two schoolteachers and friends from New Jersey, Valerie Scythes and Melissa Farah, who died within two weeks of each other in the spring. Both left behind healthy baby girls.

“At a time when maternal and infant mortality rates are decreasing throughout the industrialized world, the United States is in the unique position of having both a rapidly increasing cesarean rate and no improvement in these basic measures of maternal and infant health.” says Eugene Declercq, Ph.D., Professor of Maternal and Child Health at Boston University School of Public Health.

Another report released in October by the World Health Organization, the United Nations Population Fund, the U.N. Children's Fund, the U.N. Population Division and The World Bank, and published in the Lancet shows that the U.S. has a higher maternal death rate than 40 other countries. http://www.thelancet.com/journals/lancet/article/PIIS0140673607615724/fulltext “Women in the U.S. think they’re getting top notch care, but our death rate for mothers shows otherwise,” says Udy. The U.S.’s maternal death rate tied with that of Belarus, and narrowly beat out Bosnia and Herzogovena.

ICAN’s collection of research highlights from 2007 demonstrates the inherent risks of cesarean including a higher risk of dying in childbirth, a higher chance of suffering from potentially fatal placental problems in subsequent pregnancies, and babies having a higher chance of dying in the first year. Research from 2007 also shows that VBAC continues to be a reasonably safe birthing choice for mothers.

“The research continues to reinforce that cesareans should only be used when there is a true threat to the mother or baby,” said Udy, President of The International Cesarean Awareness Network. “Casual use of surgery on otherwise healthy women and babies can mean short-term and long-term problems.”

For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients. The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure. The guide can be found at http://www.ican-online.org/resources/white_papers/wp_vbacbanqa.pdf.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican-online.org for more information. In addition to more than 90 local chapters nationwide, the group hosts an active on-line discussion group that serves as a resource for mothers.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://www.ican-online.org/resources/white_papers/index.html

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

For women who have experienced a cesarean, who are working towards a VBAC, or simply want to know how to prevent a first cesarean, ICAN of Greater Colorado Springs is available to provide resources and support. For more information on how to get involved, contact:f Greater Colorado Springs

Bottom line: Cesarean carries twice the risk of injury and death for both mother and baby. Women with cesarean experience double the rate of hysterectomy, blood transfusion, admission to intensive care, prolonged hospital stay and death, compared to mother who delivered vaginally. Babies born by cesarean were 45 percent more likely to be in the neonatal intensive care unit for 7 days and 41-82 percent more likely to die than babies born vaginally.

Study Design: Researcher divided mothers into two groups: women with a planned cesarean after no labor and women who labored and had either a cesarean or vaginal birth and then compared rehospitalization rates.

Bottom Line:Rehospitalizations in the first 30 days after giving birth were 2.3 times more likely in planned cesarean than with planned vaginal births. The leading causes of rehospitalization after a planned cesarean were wound complications and infection. Hospital costs were 76 percent higher for women with planned cesarean, and hospital stays were 77 percent longer.

Previous caesarean or vaginal delivery: Which mode is a greater risk of perinatal death at the second delivery? (Richter, et al., European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132: 51-7)

Study Design: Researchers compared mothers who had delivered previously by cesarean vs. vaginally, and examined the number of babies who died in the subsequent pregnancy.

Bottom line: A previous cesarean delivery was associated with a 40 percent increase in perinatal death (the first week after birth) and a 52 percent increase risk of stillbirth. A vaginal or cesarean delivery in the current pregnancy did not impact the death rate.

Study Design: A common complication of any surgery is overgrowth of scar tissue, called “adhesions.” Researchers examined the frequency of adhesions with successive cesareans and whether adhesions caused by cesareans could slow down the delivery of a baby in the next pregnancy.

Bottom line: Researchers concluded that each successive cesarean significantly increases the incidence of adhesions and can slow down the delivery of a baby. One prior cesarean adds 5.6 minutes to the time it takes to deliver the baby, 2 prior cesareans 8.5 minutes, and 3 prior cesareans 18.1 minutes. This delay can compromise the health of the baby, researchers concluded.

Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy.(Yang, et al., British Journal of Obstetrics and Gynecology: 2007 May;114(5):609-13.)

Study Design: Researchers examined the incidence of placenta previa (placenta blocking the cervical opening) and placental abruption (placenta separating from the wall of the uterus prematurely) in women who have had a prior cesarean vs. a prior vaginal delivery.

Bottom line: Compared to vaginal birth, cesarean increased the risk of placenta previa by 47 percent and placental abruption by 40 percent. Both complications carry the risk of death for both mother and baby. Researchers indicated that complications may be due to the cesarean scar on the uterus.

Risks of adverse outcomes in the next birth after a first cesarean delivery. (Kennare, et al. American Journal of Obstetrics and Gynecology. 2007 Feb; 109(2 Pt 1):270-6.)

Study Design: Researchers examined the complication rate of women who delivered their first baby by cesarean vs. vaginally.

Bottom line: Women who had a prior cesarean delivery were more likely to have complications than women who had a prior vaginal delivery. Women with a prior cesarean were more likely to have a placenta previa (odds ratio [OR] = 1.66), placenta acreta (OR = 18.79), and bleeding during pregnancy (OR = 1.23). During delivery, women with a prior cesarean were also more likely to have a prolonged labor (OR = 5.89), uterine rupture (OR = 84.42), and need an emergency cesarean (OR = 9.37). Babies born to women with a prior cesarean were more likely to be small for their gestational age (OR = 1.12), have a low birth weight (OR = 1.30), and to be still born (OR = 1.56).

Study Design: Women who attempted VBAC before the estimated due date (EDD) were compared with those at or beyond 40 weeks of gestation. Researchers assessed the relationship between delivery after the EDD and VBAC failure or complication rate.

Bottom Line: The risk of uterine rupture (1.1 percent compared with 1.0 percent) or overall morbidity (2.7 percent compared with 2.1 percent) was not significantly increased in the women attempting VBAC beyond the EDD. Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

Study Design: Patients were identified who were diagnosed with incisional endometriomas (functional endometrial tissue outside the uterine cavity, within the incision) after undergoing cesarean section.

Thursday, November 29, 2007

So let's chat about childbirth education. Of the reported 30% of expecting parents who attend childbirth classes the majority go to the hospital where the birth is planned instead of seeking out independent options. I want to challenge you to think about how strange that is. Does it make sense that the information presented will REALLY be balanced, unbiased and evidence-based? Many protocols and practices used during labor and delivery in the hospital are designed as a one size fits all, no suited to each individual mom and baby. More importantly, they are not designed to suit the usual low-risk mom and baby (the majority of moms and babies are normal and low-risk), but can actually make a mom and baby appear or become high-risk. Some refer to hospital classes as "good patient preparation" classes because of lack of inclusive information. I will admit, that all hospitals do not offer education in this manner, however, in my experience and research many sadly do.

If a car salesman tried to sell you a car and actually insisted you purchase the specific color, make and model he/she decides for you, would you buy it? You would hopefully say no thank you and leave. How dare some one make such a huge decision for you. How long do you research a piece of electronics or a computer, even a cell phone plane before deciding? Even the pair of shoes you are wearing. Did you have to try on several before finding the right pair?

So why not think outside the big box, one size fits all class? Every mom, baby and partner deserve to know the wisdom of birth, understand what is normal and how to stay that way, when the abnormal happens what to do and be a skilled consumer.

There is no re-do here. This time is too important to leave to chance and inadequate education.

This is at the essence of why I teach my own childbirth classes at a location outside the hospital. I am able to freely give full spectrum information without restriction, bias or without the fear of losing my position.

Your birth matters to both you and your baby, to your future fertility, to your confidence as a mother

Below is a list of options available to families all across the US and variations in other countries as well (if if any class types have been overlooked, please let me know and I will add it).

Sunday, November 25, 2007

Picture this: An expectant mother is preparing for the birth of her baby. She chooses the care provider her friend, co-worker or family member recommended, she is reading the most popular books on pregnancy and birth (she doesn't know there are any others to choose from - everyone is reading these), she cannot help herself as she watches hour upon hour of those baby and birth shows on t.v., people tell her their birth stories and to just get the epidural (after watching those birth shows and hearing THOSE stories she is beginning to think it might just be a good idea). Right now, she is pretty sure she doesn't want to be induced (she heard it hurts more, but knowing when the baby will come is appealing) or have a cesarean but other than that she is leaving it up to her care provider.

Now she starts her childbirth class. This class is based on normal birth and evidence-based practices. Hm those books she was given are SO different than what the instructor says during class. The instructor doesn't even recommend those books but a host of other books and websites. She begins to wonder what her care provider really thinks and believes about birth. Also, what birth philosophy and practices her chosen birth location has.

I have written a list on choosing a care provider and birth location that is right for you. This is too important to make decisions without extra thoughtfulness and investigation. The key to this information is remembering you are the one purchasing a service. Essentially you are hiring a catcher with medical expertise and renting a room to birth your baby (if you are going to the hospital or birth center).

Choosing the place of birth for your baby - It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books.

Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, etc.)?

What are standard protocols that are followed?

Does location routinely use methods that turn a low risk mom and baby into high risk patients?

Are waterbirths available?

Are birthing stools or non-reclined pushing and delivery positions encouraged?

What is the no/low intervention rate?

What is the epidural rate?

What is the cesarean rate? Does the hospital support VBAC’s?

Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, etc.)

Points to Ponder afterward -

Will I be able to have the type of birth I truly desire?

What location will I ultimately feel most comfortable in?

What location is ultimately safest for my specific needs (I am currently low-risk or high risk)?

Is insurance or lack of it the reason I am choosing the location?

Do I have realistic expectations for the location?

Am I willing to take responsibility for my birth in the location?

Is staff open to working with a doula?

Is staff willing to work with natural childbirth practices?

Are there any compelling reasons to choose one location over another?

Choosing your care provider - Use this as a template for the interview process or to be certain you are of the same philosophy and belief system.

What is his/her birth philosophy?

What is philosophy of pregnancy?

Has provider seen normal labor and birth? How often?

What percentage of patients have medicalized births?

How is the "due date" approached? When is “overdue”?

Will you answer questions over the phone?

How much time will you spend with me during each appointment?

What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why?

Do I need a childbirth class? Breastfeeding class?o Are there restrictions on the type of childbirth or breastfeeding class? If so, what and why?

What routine tests are utilized during pregnancy? What if I decline these tests?

Wednesday, November 21, 2007

Yes you DO want to avoid a cesarean whenever possible. Cesarean is MAJOR surgery. It is not just another way to give birth. Both women and babies are well designed to give birth often never needing intervention of any type.

Cesarean can be a life-saving technique and used well for some serious medical conditions, including but may not be limited to placenta previa, HELLP syndrome, uterine rupture, placental abruption, cord prolapse, some breech presentations, true fetal distress, vasa previa and high order multiples.

Approximately 50-67% or more of all cesarean surgeries performed in the U.S. are likely unnecessary or become "necessary" from iatrogenic influences (non-medical inductions, AROM, pitocin augmentation, epidural or spinal anesthesia, "fetal distress", suspected big baby, lack of mobility, continuous fetal monitoring, pushing positions and/or technique).

Here are some tips to help you avoid a cesarean and have a positive vaginal birth.

Get educated: Book to start with - The Thinking Woman's Guide To A Better Birth by Henci Goer, Ina May's Guide to Childbirth by Ina May Gaskin, The Official Lamaze Guide. Giving Birth with Confidence by Lothian and DeVries. Seek out websites that use evidence-based information and normal birth practice information. TURN off the t.v. from the dramatic birthing shows unless you watch with a discerning eye to figure out what could be done differently and why. Seek out local resources such as La Leche League, Birth Network, Birth Circles and/or a local ICAN chapter to learn from other women. Take a childbirth class that is not a good patient preparation class. Take an independent evidence-based class that gives you tried and true techniques along with the communication skills to use your consumer voice. Study and learn about your rights as a pregnant woman, informed consent/refusal and all the usual interventions and medications (induction, augmentation, AROM, epidural, monitoring, etc.).

Interview Several Care Providers: You want to find out what the raw data is for inductions, interventions, epidurals, episiotomy, cesareans, VBAC's and so on. It is important to get at the core philosophy of the care provider. Email me at desirre@birthingtouch.com to receive my handout on this.

Interview several and hire a Doula: You want a doula who will fit into your philosophy of birth and labor/delivery needs. One size does not fit all.

Use normal birth practices: Stay home as long as possible in labor (if having an away from home birth), choose a care provider who supports and believes in you, use a variety of natural coping techniques, opt out of routine induction, opt out of continuous monitoring unless high risk, opt out of routine augmentation, opt out of routine epidural or narcotic use, opt out of routine pushing position, limit vaginal exams, use mobility, TRUST yourself, LISTEN to your body and baby, accept responsibility for your decisions, BE confident that you are designed for this task.

Sunday, November 18, 2007

Seems a long distance the ivory tower to the ground. The surprise in finding the thorny bushes with burrs that dig deep and puncture again at will? Well meaning onlookers say “Well a hundred years ago you both would have died?” And the farce begins. Stuff it down because it is crazy not to be grateful for the surgeon’s hand. Smile and pretend all the twisted darkness inside doesn’t really exist. The oft daily chore mixed with joy of caring for a baby whom we are unsure is truly our own. The continuing assault during lovemaking when a cringe comes from the depths when a loving and hungry hand brushes the incision site. “How can he think I am beautiful? How can he possibly want this?” Another thing of beauty and perfection quashed underneath the burden of the surgeon’s handprint. Oh no say it hasn’t already been a year. The birthday. THE birthday sounds so exciting but terror strikes. Preparation to be happy, preparation to feel joy. Preparation not to shortchange our amazing gift of a child under the pain of the surgeon’s knife print.

The anticipated day meant to birth us into motherhood and my child into my waiting hands to my craving breasts, I was birthed into the Sisterhood of the Scar forever.

These days political correctness seems to rule the world (at least the United States). We have become so easily offended that we often miss the truth and follow parcels of truth weighted down by vast untruth for someone else to gain from in some way, not for the health and safety of our bodies or our children.

Language matters. Language can affect how we perceive our bodies, our designed in capabilities and our baby. Language has the ability to strengthen confidence or smash it to pieces in one single moment.

Below is a list that is purposed to make you the reader stop and think. Take the almost ho-hum usual and shed new light on it.